With increasing reports of death in COVID-19 patients on ventilators, many doctors are concerned in certain patients ventilators may be doing more harm than good. This concern shows the evolving nature of coronavirus treatment as doctors still figure out the best approach to manage critical cases of COVID-19. Presently, all treatment for coronavirus is based on concurrent data being published and updated every day amidst the challenge of providing care to rising numbers of cases with limited medical supplies.
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Ventilators are machines used to supply oxygen to prevent hypoxic death in patients with progressive lung failure. Prior to operating a ventilator, the patient is sedated to enable insertion of a tube through the throat. Considering the fact that ventilators are needed only in patients who are in a critical state, higher mortality is expected.
Usually, patient put on ventilators have a high mortality rate of upto 50 percent regardless of the cause of respiratory distress. But in coronavirus patients, the mortality rate is alarmingly high at 80 percent justifying the concern from doctors for ventilators.
Similar reports of unnaturally high mortality rates in coronavirus patients on mechanical ventilators have also been reported in other countries including China and the United Kingdom. In Wuhan, the mortality rate in patients put on ventilators has been reported to be about 86 percent while in U.K., it is estimated to be 66 percent.
Despite of parallel findings across the globe in ventilator associated deaths, the underlying mechanism has not been identified as of yet. Some experts say the probability of dying while on a ventilator is directly related to the severity of illness at the time of mechanical ventilation.
While some health providers also speculate the susceptibility for these patients to succumb to ventilator associated complications may be higher. In any case, prolonged ventilator use can be harmful for anyone due to forceful entry of high-pressure oxygen into the tiny alveolar sacs.
“We know that mechanical ventilation is not benign,” said Dr. Eddy Fan, an expert on respiratory treatment at Toronto General Hospital. “One of the most important findings in the last few decades is that medical ventilation can worsen lung injury — so we have to be careful how we use it.”
Nevertheless by regulating the pressure and number of breaths, the damage from mechanical ventilation can be controlled to certain extent.
Furthermore, the prolonged requirement of ventilators in COVID-19 patients also substantially increases their risks for complications. Unlike bacterial pneumonia which only requires a few days of ventilation, COVID-19 patients need seven to ten days of mechanical ventilation before their lungs can recover.
“The ventilator is not therapeutic. It’s a supportive measure while we wait for the patient’s body to recover,” said Dr. Roger Alvarez, a lung specialist with the University of Miami Health System in Florida.
Until a few days ago, any patient presenting with respiratory distress was routinely placed on mechanical ventilators. But with reports of such high mortality rates, many doctors are refraining from putting COVID-19 patients under mechanical ventilators resorting to alternative options instead. Some of these options include altering positions of patients to aerate different parts of the lungs while also providing oxygen supplementation with nitric oxide. Nitric Oxide can result in vasodilation and improve blood flow.